Formation of the Center for Cardiovascular Health Research
The Center for Cardiovascular Health Research (CCHR or the Center) will be housed at MTPPI to foster collaborative research in cardiovascular, clinical and health services research. The Center will study issues concerning patient access to health care and the extent to which reimbursement policies and insurance cover the new technologies, procedures, and regimens.
Prevalence of cardiovascular disease
A staggering estimated 64.4 million, or one in five, Americans has one or more forms of cardiovascular disease (CVD). Due to a markedly aging population, growing presence of CVD risk factors, and a continued disproportionate improvement in the management of acute (in contrast to chronic) cardiovascular conditions, the number of patients living with chronic forms of heart disease – namely, heart failure, coronary artery disease, and stroke – will undoubtedly escalate in the years ahead.Social and economic burden of cardiovascular disease
Cardiovascular disease is the leading cause of death and disability in the United States, and is estimated to cost $368.4 billion per year including direct and indirect costs. The adoption of unhealthy lifestyles, including sedentary behaviour and poor dietary habits, among many teenagers and young adults is leading to earlier onset of heart disease risk factors and heart disease, itself. This trend has important implications for domestic productivity and the welfare of the U.S. population.Effectiveness of clinical intervention
Multiple strategies ranging from lifestyle modification to the utilization of complex surgical and pharmaceutical treatments can aid in the management of CVD. When used properly, many of these treatments can be highly efficacious. The high costs and risk of serious adverse events, which accompany many of these treatments, however, requires careful consideration of patients' conditions and susceptibilities to harm from inappropriate utilization.Challenges of management
Independent risk factors, identified from epidemiological research, and a vast array of diagnostic techniques, spanning the gamut from office-based sphygmomanometry to coronary angiography, guide effective CVD patient management. While expensive diagnostic tests are typically less frequently applied to low-risk, asymptomatic patients, they are widely used for advanced risk stratification among high-risk patients or survivors of myocardial infarction. An assessment of the relative risks and incremental value of each of these tests is necessary for determining optimal strategies in CVD diagnosis and management.
Because of the ongoing need for information by clinicians, researchers, and policy-makers regarding coverage of new services, the Center plans on issuing semi-annual reports regarding new and emerging cardiovascular medical technology which are integral to a fuller understanding of the progress in the care and treatment of CV patients. For example, the Center will address the following research objectives:
Compare efficacy of various paths consisting of:
Diagnostic tests Treatments and interventions Cardiac events
Measure costs associated with various paths
The objective of this study is to develop a database of the histories of cardiovascular tests, treatments, and events for a large population of adult patients. Subsequently, we intend to use these histories to describe the impact of a variety of diagnostic tests in terms of the efficacy and costs of the resulting treatments. This approach is a critical component in the development process for Markov decision models, which can help determine the impact of changes in the management of CVD as patients progress through various condition-specific health pathways.
Examine CVD treatment and outcomes for specific subpopulations
Women, the elderly, minorities, persons with low socioeconomic status, and persons with end-stage renal disease are groups with a paucity of data regarding their treatment and outcomes. The existing data suggest possible disparities in the use of appropriate technologies to identify and treat CVD.
The resulting information that we acquire from this project will enable us to apply a cost associated with an increase in specificity or sensitivity of the diagnostics applied at each stage of the process. For instance, if a patient undergoes an angiogram and is then treated with a pharmaceutical regimen only -- the average cost of such regimen could be $3,000 over the following year and cost of the more aggressive treatment could be $5,000 over the following year. The $2,000 savings will be realized for each additional patient for whom an improved or additional test correctly indicates that the less aggressive therapy will be sufficient. And conversely, if, subsequent to testing, patients who are given the less aggressive therapy go on to experience an adverse cardiac event resulting in medical care costs in excess of $10,000 over the next year, then the savings for each additional patient who is correctly identified as requiring more aggressive treatment is $5,000. By comparing the costs and probabilities of these events and transitions, we will be able to estimate the impact of improvements in the patient management process. Such estimates will be a valuable guide for understanding and focusing efforts to assist in the management of serious cardiovascular diseases.
MTPPI staff woll be collaborating with clivicians and researchers from the Johns Hopkins School of Medicine, Division of Cardiology.
The Center will report its findings through MTPPI reports utilizing the internet and the peer-reviewed literature. Those interested in learning more about the Center's activities may contact MTPPI at 301-652-4005, by fax at 301-652-8335, or by e-mail at chhr@mtppi.org.